Research Reports - The effect of physical exercise after a concussion

Am J Sports Med. 2017 Jun 1:363546517706137. doi: 10.1177/0363546517706137. [Epub
ahead of print]

Lal A(1), Kolakowsky-Hayner SA(1), Ghajar J(1)(2), Balamane M(1).

BACKGROUND: Data evaluating the role of exercise in patients with a concussion
are contradictory. Studies have reported improvement in the Post-Concussion
Symptom Scale (PCSS) score, whereas others showed no effect on the PCSS score.
PURPOSE: To conduct a systematic review and meta-analysis on the role of physical
exercise on different outcomes in patients with a concussion.
STUDY DESIGN: Systematic review and meta-analysis.
METHODS: A search of 5 databases from the earliest available date to September
30, 2016, and a hand search of a few articles were performed. Trial registries
were reviewed, and authors of multiple studies were contacted to find additional
published or unpublished studies. Randomized controlled trials (RCTs), cohort
studies, and before and after (pre-post) studies evaluating the effect of
physical exercise, compared with control, in patients with a concussion or mild
traumatic brain injury were included.
RESULTS: The search generated 1096 studies. Of these, 14 studies (5 RCTs, 1
propensity score matching study, 3 cohort studies, and 5 before and after
studies) met our inclusion criteria. Exercise significantly decreased the PCSS
score (mean difference, -13.06; 95% CI, -16.57 to -9.55; P < .00001; I(2) = 44%),
percentage of patients with symptoms of a concussion (risk ratio, 0.74; 95% CI,
0.63 to 0.86; P = .0001; I(2) = 0%), and days off work (17.7 days vs 32.2 days,
respectively; P < .05) compared with control. Exercise improved the reaction time
(standard mean difference, -0.43; 95% CI, -0.80 to -0.06; P = .02) component of
the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) score
without affecting the Balance Error Scoring System (BESS) score and
neuropsychological parameters. The Grading of Recommendations Assessment,
Development and Evaluation (GRADE) scores were moderate for the PCSS, symptoms,
ImPACT, BESS, and neuropsychological tests.
CONCLUSION: Physical exercise appears to improve the PCSS score and symptoms in
patients with a concussion. A high-quality RCT evaluating different intensities
of exercise at different time points, for different durations after a concussion,
for different races/ethnicities, and for sex needs to be conducted to evaluate a
clear effect of exercise in patients with a concussion. 

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